Community Veterinary Medicine Programs: Pet Owners' Perceptions and Experiences
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ORIGINAL RESEARCH
published: 08 June 2021
doi: 10.3389/fvets.2021.678595
Community Veterinary Medicine
Programs: Pet Owners’ Perceptions
and Experiences
Lori R. Kogan 1*, Veronica H. Accornero 2 , Emily Gelb 3 and Margaret R. Slater 2
1
Clinical Sciences Department, Colorado State University, Fort Collins, CO, United States, 2 Strategy and Research, The
American Society for the Prevention of Cruelty to Animals, New York, NY, United States, 3 Sheltering and Veterinary Services
Department, The American Society for the Prevention of Cruelty to Animals, New York, NY, United States
Many American pet owners struggle financially, and the COVID-19 pandemic has only
exacerbated this problem. Yet, the positive effects that companion animals have in
people’s lives create the need for supportive systems to ensure that financial limitations,
and other barriers, do not preclude pet ownership. To help address these barriers,
and reach underserved communities, various forms of community-based veterinary
medicine programs have been developed across the country. This study assesses two
Edited by:
community-based veterinary programs in North Carolina, USA. In addition to perceptions
Benjamin Hart, surrounding veterinary services, this study paid specific attention to communication and
University of California, Davis,
respect; two additional elements needed for successful community-based veterinary
United States
programs. Surveys were given to clients accessing Asheville Humane Society (AHS)
Reviewed by:
Rachael Kreisler, mobile veterinary care clinic and Asheville Humane Society (AHS) Affordable Pet Care
Midwestern University, United States Clinic. Results of the anonymous survey indicate that the majority of clients had
Vera Baumans,
Utrecht University, Netherlands
positive veterinary care experiences in terms of both veterinary services and client
*Correspondence:
communication. In conclusion, low-cost or free community veterinary programs—with
Lori R. Kogan effective communication, empathy, and cultural competence—can help open the door
lori.kogan@colostate.edu
to future positive veterinary experiences for disadvantaged pet owners.
Specialty section: Keywords: community program, financial limitations, access, low-cost veterinary care, disadvantaged pet owners
This article was submitted to
Veterinary Humanities and Social
Sciences, INTRODUCTION
a section of the journal
Frontiers in Veterinary Science
It is estimated that 38% of US households include at least one dog and 25% include at least one
Received: 10 March 2021 cat (1) with the majority of these owners reporting that their pets are part of their family (2). The
Accepted: 10 May 2021 inclusion of pets in the household has been shown to offer numerous physical, emotional, and social
Published: 08 June 2021
benefits (3–12). Studies exploring the benefits of pets for vulnerable populations suggest similarly
Citation: positive effects. Schmitz et al. (13), for example, found that LGBTQ+ young adults report that
Kogan LR, Accornero VH, Gelb E and their pets play a critical role in helping them manage major life stress and depression (13). Studies
Slater MR (2021) Community
involving homeless individuals have found that their pets provide them with a myriad of benefits
Veterinary Medicine Programs: Pet
Owners’ Perceptions and
including safety, personal responsibility and improved emotional and mental health (14–16).
Experiences. A substantial number of Americans, many of which are pet owners, struggle financially;
Front. Vet. Sci. 8:678595. with the COVID-19 pandemic only exacerbating this problem (17–19). This means that
doi: 10.3389/fvets.2021.678595 many families are struggling to pay their bills, including the ability to afford the
Frontiers in Veterinary Science | www.frontiersin.org 1 June 2021 | Volume 8 | Article 678595Kogan et al. Community Veterinary Medicine Programs
veterinary care their pets need to stay happy and healthy (20). comfortable using) and questions pertaining to the pet obtaining
Yet, the myriad of positive effects that companion animals have veterinary care. Potential barriers to care were assessed along with
in people’s lives suggest the need for supportive systems to ensure owners’ perception of the care and communication they received
that financial limitations do not preclude pet ownership (21). during their last visit to the clinic. The perception questions
The inability to access veterinary care is not simply a were adapted from the Client Satisfaction Questionnaire (25).
financial problem. Numerous barriers to veterinary care have These questions included perceptions of respect, empathy,
been identified and all need to be addressed in order to communication and consideration of their culture and beliefs,
support vulnerable pet owners. While financial barriers are and asked participants to rate each item on a 3-point scale
the most common (21), and create the most stress within the (good, neutral, and poor). Additionally, participants were asked,
veterinary profession, other barriers include hours of operation, hypothetically, to indicate how important the received veterinary
geographical location, transportation, equipment to transport care was in helping them keep their pet using a 3-point scale
pets, cultural/language related issues, and veterinarian–client (very important, moderately important, and not important).
communication (16, 21, 22). An unfortunate consequence of Upon completion of the survey, all participants were entered
these barriers is that low income individuals in underserved into a raffle for a local grocery store gift card. The survey was
communities are frequently neglected by animal care providers reviewed by staff members of both Asheville Humane Society
(21). Yet, increased veterinary care access in these underserved and The American Society for the Prevention of Cruelty to
areas can help reduce animal overpopulation, improve animal Animals (ASPCA) to assess face validity and again after being
welfare and overall community health (23). placed online utilizing Qualtrics. This study was approved by
To help address these barriers, and reach these underserved the Human Subjects Review Board of Colorado State University
areas, many communities have implemented some form of (20-10370H). Data were analyzed with IBM SPSS Statistics 26
community-based veterinary medicine programs. Community- statistical software.
based veterinary medicine initiatives are seen as one method to The two programs assessed included Asheville Humane
address the lack of access to veterinary care among underserved Society (AHS) mobile veterinary care clinic (targeting all clients
communities (23) with community veterinarians seen as pivotal who accessed services between 11/2017–11/2019), and Asheville
players in fostering positive interactions and experienced with pet Humane Society (AHS) Affordable Pet Care Clinic (targeting all
owners through education and veterinary care (24). clients who accessed services between 3/1/18–3/1/20). Asheville
Despite the growing number of community-based veterinary Humane Society mobile veterinary care clinic (MVC) consisted
medicine initiatives, little research has been conducted on of one veterinarian, one veterinary technician, and two AHS staff
the topic, with most published work focused on veterinarian members and provided services to underserved communities
and student opinions or client demographics. Therefore, the approximately twice a month. The unit typically spent 2–3 h
quality of these programs, as well as their impact on the in one community before traveling to the next; visiting three
targeted population, is largely unknown. It has been suggested communities during each outing and servicing ∼9 owners and
that there is a need for empirical research that explores the 12 pets at each location. The type of services the unit provided
efficacy and potential impact of these community initiatives included injury care, illness visits, vaccinations, wellness exams,
(22). This study addresses this call by assessing two community- and medical grooming. Pet owners were seen on a walk-in basis
based veterinary programs in located in North Carolina, USA. with a typical wait time of ∼15–30 min. A Spanish-speaking
Given the significant impact that good communication between AHS staff member was present to translate, and all services were
veterinarians and pet owners can have on pet health care, this provided free of charge.
study paid specific attention to this critical element needed for Asheville Humane Society Affordable Pet Care Clinic (APCC)
successful community-based veterinary programs. was originally housed in the AHS adoption center, and then
moved to a nearby veterinary clinic until it was permanently
relocated to the new AHS community center building in 2019.
MATERIALS AND METHODS The clinic was open once a month and offered reduced-cost
services including illness and injury-related care as well as
The perceptions and experiences of all pet owners who accessed vaccinations and wellness exams. Clients were seen on a walk-
veterinary care through one of two community-based programs in basis, with typical wait times of ∼30 min. The clinic typically
in North Carolina, USA were garnered through an online, served 11-12 clients and 20 pets with a staff that consisted of one
anonymous survey created in Qualtrics. All participants were local veterinary hospital’s veterinarian, veterinary technician and
sent a text message asking for their participation with an additional staff member as well as 3–4 AHS staff members. A
accompanying URL link and two follow-up text reminders. Spanish-speaking AHS staff member was on hand to translate.
Follow-up phone calls and phone-based surveys were offered Patient transportation to and from the clinic was provided upon
to owners who did not respond to the text requests. The request. Due to liability, APCC was not able to provide owner
link directed them to a survey that began by explaining the transportation. Owners could join their pet by finding other
purpose of the study and their rights as participants. The means of transportation or remain at home and receive updates
survey included demographic items (i.e., gender, employment and communication as needed during and after the appointment
status, household income, age, ethnicity, race, and language most via telephone or text message.
Frontiers in Veterinary Science | www.frontiersin.org 2 June 2021 | Volume 8 | Article 678595Kogan et al. Community Veterinary Medicine Programs
RESULTS TABLE 1 | Demographics of pet owners utilizing services at APCC and MVC.
A total of 64 surveys were completed by pet owners who APCC n = 59 MVC n = 31
accessed the APCC program (42.7% of the total number (n = Gender
150) of APCC users between 3/1/18–3/1/20). The respondents Male 18 (30.5%) 5 (16.1%)
included 45 (71.4%) dog owners, 17 (27.0%) cat owners and Female 38 (64.4%) 22 (71.0%)
1 (1.6%) owner who reported owning both a cat and dog. Other 1 (1.7%) 2 (6.5%)
For the MVC survey, a total of 33 responses were received Prefer to not answer 2 (3.4%) 2 (6.5%)
(24.4% of the total number of MVC users, n = 135, between
11/2017–11/2019). These users included 23 (69.7%) dog owners, APCC n = 59 MVC n = 30
7 (21.2%) cat owners and 3 (9.1%) owners who reported owning
Ethnicity
both a cat and dog. The majority of pet owners utilizing
Hispanic or Latino 4 (6.8%) 2 (6.7%)
these programs were White, non-Hispanic females with annual
Not Hispanic or Latino 53 (89.8%) 25 (83.3%)
household income ofKogan et al. Community Veterinary Medicine Programs
common barrier noted by MVC clients pertained to uncertainty men and women (28). Employment changes due to COVID-19
about the mobile unit’s schedule and hours (Table 5). can be seen within this study’s sample.
While some might propose that people without the financial
means to care for a pet should not have one, we argue that
it is not acceptable, nor ethical, to deny families the option to
DISCUSSION
have a pet due to barriers in accessing veterinary health care.
Pets are seen as important members of the family for many, As noted by Wiltzius et al. suggesting that people with limited
offering happiness, comfort and support. Yet, many families means should not have pets is an “untenable solution” (21).
struggle to provide their pet the veterinary care they need to stay Additionally, with research suggesting that pets play a critical role
healthy. Even before the COVID-19 pandemic, it was estimated in mitigating COVID-19 related stress (29–31), and numerous
that 23 million pets live with impoverished families (26) and antidotal reports that pet adoptions have dramatically increased
this problem has only been exacerbated with the pandemic (27). since the pandemic began, it is more critical than ever to support
Further, numerous shelters have reported substantial adoption these vulnerable pet owners. Assisting these families that struggle
rate increases as people have been spending more time at home. with financial constraints that prevent them from accessing
The financial ramifications of COVID-19, as evidenced in the veterinary care could help them keep their pets at home (20).
current study, have not impacted all groups of people equally; To address these barriers, many communities have created
unemployment rates for young Black and Hispanic men and a variety of low-cost or free veterinary programs. Yet, not
women, for example, are much higher than that for young White everyone is supportive of such programs. There is a common
misconception that providing discounted or free veterinary
services will take paying clients away from nearby veterinary
hospitals, despite the fact that studies have consistently
TABLE 3 | Stated reasons for most recent visit to APCC and MVC and report of shown that the majority of owners accessing these services
previous veterinary care. have not seen a veterinarian before (21, 32). Our study
found similar results, whereby 55% of pets seen through the
APCC n = 64 MVC n = 33
MVC and 43% seen at the APCC had never been to a
REASON FOR MOST RECENT VISIT veterinarian before.
Preventative While cost is the most common barrier to veterinary health
Vaccinations 30 (46.9%) 21 (63.6%) care, as well as a determinate factor in relinquishment decisions
Wellness exam 18 (28.1%) 9 (27.3%) (20, 33, 34), financial limitations are not the only barrier
Sick Care
to veterinary care that must be addressed. Accessibility and
Illness 24 (37.5%) 9 (27.3%)
transportation are additional key components that must be
Injury 2 (3.1%) 1 (3.0%)
considered to ensure pets receive the care they need. It is not
Other (fleas) 6 (9.4%) 5 (15.2%)
enough to make veterinary care affordable; it must also be
Other 9 (14.1%) (eye or ear 5 (15.2%) [microchip,
easily accessible. Transportation is a potential barrier that poses
problems, stitch nail trim (2), anal unique challenges for veterinary care. Owners without a car may
removal, hair loss, glands, dog needed be forced to rely on public transportation that does not allow
allergy, anal glands, home] animals. Alternative options, such as private transportation in the
microchip, deworming) form of taxis or Uber rides, if available in their community, can
Don’t know/remember 1 (3.0%) be cost prohibitive. This lack of transportation can be a challenge
even if a veterinary clinic is just a few miles away. There is a need
APCC n = 63 MVC n = 33
for veterinary services to come to these owners in the form of
PREVIOUS VETERINARY CARE mobile clinics.
Yes—in the previous 3 years 31 (49.2%) 12 (36.4%) Regardless of the type of low-cost or free community
Yes—but not in the previous 4 (6.3%) 2 (6.1%) veterinary program created, it is imperative that it offers a
3 years positive experience for the pet owner. This involves attention to
No 27 (42.9%) 18 (54.5%) communication and cultural competence. Good communication
Don’t know/don’t remember 1 (1.6%) 1 (3.0%) between veterinarians and pet owners is critical and has
TABLE 4 | Rating of most recent veterinary visit by pet owners utilizing services at the MVC and APCC.
Agree Neutral Disagree DK
MVC APCC MVC APCC MVC APCC MVC APCC
I felt respected by the staff 31 (97%) 59 (98%) 0 1 (2%) 0 0 1 (3%) 0
I believe the staff genuinely care about me and my pet 32 (97%) 58 (97%) 0 2 (3%) 1 (3%) 0 0 0
Frontiers in Veterinary Science | www.frontiersin.org 4 June 2021 | Volume 8 | Article 678595Kogan et al. Community Veterinary Medicine Programs
FIGURE 1 | Rating of most recent veterinary visit by pet owners utilizing services at the APCC and MVC (excluding don’t know responses).
TABLE 5 | Pet owners’ perceived barriers to accessing veterinary care at APCC with their veterinarians; one in which they are involved
and MVC. in the decision-making process (42, 43). Clients want their
Program APCC n = 64 MVC n = 33 veterinarians to take time to listen to them and clearly explain
diagnoses and recommendations (44). In addition to being heard,
Unsure of clinic 13 (20.3%) 9 (27.3%) clients want their veterinarian to be empathic; defined as the
schedule/hours ability to take the perspective of the client and demonstrate
Inability to get time off from 4 (6.3%) 3 (9.1%) compassionate care (45). The ability to convey empathy has
work/school
been shown to help develop rapport, establish trust, and
Hours/days the Affordable 7 (10.9%) 2 (6.1%)
increase compliance; all of which lead to better patient outcome
Pet Care Clinic is open
(46–48).
Language barrier 0 0
A key component of a mutually respectful collaborative
Did not have the money 19 (30.0%) Not applicable
relationship includes cultural competence, which can be defined
Transportation problems 14 (21.9%) Not applicable
as awareness, behaviors, knowledge, attitudes, skills, and policies
Don’t know 0 1 (3.0%)
that all come together to enable people to work effectively
Other 6 (9.4%) (ability to 5 (15.2%)
in cross-cultural situations (45, 49). Demonstrating cultural
make appointment, (homebound, owner
childcare, mobility issues, safety competence when communicating with clients invites mutuality
miscommunication, concerns, unsure and inclusion, leading to higher client satisfaction and improved
COVID-19-related about location. animal health (49). While enhanced cultural competence cannot
issue) compensate for other barriers to veterinary care, it can help. Pet
owners who feel respected and heard are more likely to seek out
care and follow medical recommendations (49).
been shown to lead to better clinical outcomes, higher client Effective communication, empathy, and cultural competence
satisfaction, and increased compliance with recommended care are all needed to ensure a positive client experience. We suggest
(35–38). While traditionally veterinarian-client relationships that it is not enough to offer low-cost community veterinary
were more paternalistic, a “relationship-centered” approach programs that do not excel in all of these critical areas. Given the
has more recently been promoted. This approach is one of fact that the majority of pet owners utilizing these community
balanced power between the client and veterinarian and is resources have limited prior veterinary medicine experience, it
based on mutuality, negotiation and joint agreement (39– is imperative that these experiences are positive to enhance the
41). Recent studies investigating veterinary communication chances that they will seek out subsequent veterinary care. This
have suggested that clients prefer a collaborative partnership study is one of the first to assess these critical components.
Frontiers in Veterinary Science | www.frontiersin.org 5 June 2021 | Volume 8 | Article 678595Kogan et al. Community Veterinary Medicine Programs
The results from this study suggest that it is possible to create and a positive ongoing relationship between pet owners, their
low-cost community programs that satisfy clients’ needs to pets, and veterinary professionals.
be heard, valued and respected. For example, over 90% of
clients from both programs reported feeling their veterinarian DATA AVAILABILITY STATEMENT
respected their culture/beliefs and recognized the role their pet
played in their lives. Most owners also reported feeling their The raw data supporting the conclusions of this article will be
veterinarian wanted to hear their opinion, discussed options and made available by the authors, without undue reservation.
recommendations, and included them in the entire veterinary
visit. Additionally, over 85% reported trusting the veterinary ETHICS STATEMENT
team and feeling the community service was important in helping
them keep their pet. With such positive experiences, it seems The studies involving human participants were reviewed and
likely that the groundwork has been laid for these owners approved by Colorado State University Regulatory Compliance
to access available and accessible veterinary care services in Committee. Written informed consent for participation was not
the future. required for this study in accordance with the national legislation
Limitations to this study include the fact that it focused on and the institutional requirements.
only community programs and the survey was not available in
Spanish. Further study on additional programs, as well as views AUTHOR CONTRIBUTIONS
from all entities involved, is suggested. In summary, there is
a growing need to assist the number of families who cannot LK analyzed the data. All authors conceived the study design and
access veterinary care. Low-cost or free community programs involved with the manuscript writing and editing.
offer one potential solution, but care must be taken to ensure
the experience is a positive one for all involved. Careful attention FUNDING
to communication, empathy and cultural sensitivity are critical
in ensuring the success of such programs. In this way, these This study was funded by The American Society for the
programs create a positive foundation for future veterinary care Prevention of Cruelty to Animals.
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